tbuckley/cabot-search huggingface dataset:
Abstract 10430: Radial First! Ulnar Next? Forearm Arterial Anatomy Study
Authors: Prabhakaran Gopalakrishnan, Blake Campbell, Shakthi Prabhakaran, Tahir Shah, Su Sandi Aung, Yan Naung Htay
Journal: Circulation (2022)

Introduction: In patients with small Right Radial Artery ( RRA ), access site failure may result in a radial to femoral crossover. Methods: The arterial anatomy of the distal forearm was studied using ultrasound in 167 hospitalized patients. The radial and ulnar artery dimensions were imaged in triplicates. The average cross-sectional area (CSA) and average diameter (AD) were measured using open-source ImageJ software. Variations in distal forearm arterial anatomy (branches) were documented. Results: The mean CSA and AD for the largest of the bilateral radial and ulnar arteries - Largest Forearm Artery ( LFA ), were 5.4 ± 2.5 mm 2 (1.1 → 13.3 mm 2 ) and 2.6 ± 0.6 mm (1.2 → 4.1 mm) respectively. The mean CSA and AD for RRA were 4.8 ± 2.5 mm 2 (0.7 → 13.3 mm 2 ) and 2.4 ± 0.6 mm (0.9 → 4.1 mm). In 46% of patients, RRA was not the LFA. The ulnar artery was larger than the radial artery in 25% of patients in the right wrist and 29% in the left wrist. The left radial was larger than the right radial in 31% and the left ulnar was larger than the right ulnar in 42%. In 58% of patients, RRA was &lt; 2.5 mm (outer diameter of common radial access sheaths). In 24% of patients, RRA was &lt;2 mm. In patients with RRA &lt; 2.5 mm, 17% had another artery &gt;2.5 mm and 6% had another artery &gt; 3 mm. Men had 53% larger CSA compared to women. Smoking, intravenous drug use, diabetes, hyperlipidemia, peripheral vascular disease, chronic kidney disease (CKD), and hemodialysis predicted smaller-sized forearm arteries. CKD patients had 33% smaller CSA compared to patients without CKD. In 23 patients (14%), one or more of the forearm arteries had branches in the distal forearm. In 12 patients (7%), branches were seen in RRA. Conclusions: Right Radial Artery was not the largest forearm artery in almost half the patients. Right Radial Artery was smaller in size than common radial access sheaths in more than half of the patients. Of these patients, 17% had a different forearm artery &gt; 2.5 mm that could be accessed instead of Femoral Artery. Female sex and CKD predicted smaller forearm artery sizes increasing the risk of radial access failure. Ultrasound use is advisable to identify the best forearm artery for access and avoid accessing smaller accessory branches that were seen in 7% of right radial and 14% of one or more forearm arteries.
Abstract 10283: Socioeconomic Disparities in Overall and Morbidity Free Survival of Infants With Single Ventricle Heart Disease
Authors: Flora Nunez Gallegos, Yuen Lie Tjoeng, Mehren Iqbal, Gloria Lehmann, Olga Saynina, Titus Chan, Claudia Algaze
Journal: Circulation (2022)

Prior studies have demonstrated higher odds of mortality for non-white and lower socioeconomic status patients with single ventricle (SV) heart disease. However, these studies have not examined survival through staged surgical palliation or rates of morbidity in this patient population. We hypothesized that non-white race/ethnicity and lower socioeconomic status were associated with lower overall survival and increased morbidity through 1 st birthday in patients undergoing SV palliation. Patients with SV heart disease, live birth, and planned SV palliation in the National Pediatric Cardiology Quality Improvement Collaborative between January 1, 2016, and December 31, 2020, were included. Race/ethnicity, payer, and neighborhood characteristics were analyzed. Morbidity was defined as acute neurological events, unplanned procedures, renal support, cardiac arrest, extracorporeal life support, necrotizing enterocolitis, or surgical site infection. Morbidity-free survival was defined as survival through each stage of palliation without experiencing one of the above morbidities. Cox proportional hazards and multivariable regression modeling were performed to evaluate the association between socioeconomic variables, race/ethnicity, and overall morbidity-free survival to 1st birthday. There were 2,184 live births with an overall survival to 1st birthday of 76%. There was no difference in survival to 1st birthday between non-Hispanic White, non-Hispanic Black, and Hispanic patients. Patients with government insurance had decreased survival prior to their 1st birthday (HR 0.79, 95% CI 0.64, 0.98 vs commercial insurance). Infants with government insurance had lower morbidity-free survival during stage 1 (OR 0.72, 95% CI 0.59, 0.87) and stage 2 (OR 0.67, 95% CI 0.52, 0.85) hospitalizations. Patients with “Other” race/ethnicity had lower odds of morbidity-free survival to one year of age (OR 0.68 95% CI 0.47, 0.98). Household income and deprivation index were not associated with survival or morbidity. Infants with government insurance experienced decreased survival to 1st birthday, and those of “Other” race/ethnicity had lower morbidity-free survival. Addressing disparities in these patient populations is an area of ongoing need.
Abstract 10623: Association of Changes in Glycemic Status and Risk of Cardiovascular Disease Among Adults With Hypertension - A Post-Hoc Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)
Authors: Drew Levy, Kobina Hagan, Miguel Cainzos Achirica, Khurram Nasir, Ambarish Pandey, Kershaw Patel
Journal: Circulation (2022)

Introduction: Prediabetes (preDM) is a risk factor for diabetes mellitus (DM) and both are associated with elevated risk of cardiovascular disease (CVD). However, the association of transitions in glycemic status with cardiovascular disease (CVD) is not well established. Methods: The present study included participants with hypertension enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT) without DM at baseline. Study participants had available fasting plasma glucose (FPG) at baseline and 2-year follow-up and no primary outcome CVD event (myocardial infarction, other acute coronary syndrome, stroke, heart failure, or cardiovascular death) prior to 2 years. Euglycemia, preDM, and DM status were defined based on FPG, self-reported history, or use of glucose-lowering medication. Participants were stratified by glycemic status at baseline and 2-year follow up. The association of changes in glycemic status with CVD risk were assessed using adjusted Cox models. Results: The present study included 4,708 participants (33.6% women, 35.1% Black, 41.4% preDM). Among 2,760 participants with euglycemia at baseline, 716 (25.9%) developed preDM or DM over 2-year follow-up. Most participants with baseline preDM continued to have preDM or progressed to DM (71.3%). After the 2-year visit, 151 participants (3.2%) had a CVD event. Participants with persistent euglycemia had fewer CVD events (2.6%) compared with those with incident preDM or DM on follow-up (4.5%) (Figure 1A). In adjusted analysis, among participants with baseline euglycemia, those who developed prediabetes or diabetes had 70% higher risk of a CVD event during follow-up compared with those with persistent euglycemia (HR [95% CI], 1.70 [1.09-2.64]) (Figure 1B). Conclusions: In adults with hypertension, worsening glycemic status from euglycemia to preDM or DM was associated with higher risk for CVD. Prevention of dysglycemia may be an important target to prevent CVD in hypertension.
Abstract 10768: Double Whammy: An Unusual Case of Mycotic Abdominal Aortic Aneurysm in a Bacteremic Patient - Case Report
Authors: Maria Monica Valdez, Dana Rosielou L Rubiano, Milagros E Yamamoto, Jose S Yamamoto
Journal: Circulation (2022)

Introduction: Ruptured mycotic aortic aneurysm is a relatively rare, life-threatening disease, which is associated with remarkable mortality. In East Asia, mortality caused by this disease is high and it is commonly caused by Salmonella species. Majority of cases of mycotic aneurysms caused by Salmonella were in the abdominal aorta wherein most of them presented with chills and fever while some presented with diarrhea from 2 days to 1 month before the aneurysm was diagnosed. Patients who present with diarrhea and abdominal pain are likely to be missed. It is therefore important that mycotic abdominal aneurysm be recognized early, and prompt treatment be initiated. Case: A 78-year-old American male, Philippine immigrant with history of ischemic stroke and chronic smoking presented with diarrhea and severe abdominal pain. Complete blood count showed leukocytosis with neutrophilic predominance. A computed tomography scan of whole abdomen exhibited a fusiform aneurysm of the infrarenal abdominal aorta with large periaortic hematoma indicating prior rupture. Open abdominal aortic aneurysm repair was successfully done and intravenous Meropenem and Ciprofloxacin were given. Blood, urine, thrombus, and aortic plaque cultures were obtained and all revealed Salmonella specie with same antibiogram. Intravenous Meropenem and Ciprofloxacin was transitioned to intravenous Ceftriaxone and was continued for 6 weeks post-operatively. Conclusion: Mycotic abdominal aortic aneurysm can be diagnosed with the combination of clinical symptoms, laboratory, radiological findings, and intraoperative findings. However, vague and non-specific symptoms do not rule out the diagnosis. High index of suspicion and low threshold for CT imaging is necessary in any patient age &gt;60 years who present with abdominal pain and with previous history of gastroenteritis. Prompt initiation of antibiotic therapy and surgical intervention are the treatment of choice.
Abstract 10465: Abnormal Post Exercise Skeletal Muscle Microvascular Response and Metabolism Correlate With Patient Reported Outcomes in Patients With Intermittent Claudication From Peripheral Artery Disease
Authors: Sanjay Divakaran, Hans Harms, Matthew Robertson, Sai Merugumala, Mi-Ae Park, Marie Kijewski, Laurel Martell, Victoria Morgan, Leanne Barrett, Anna Perillo, Courtney Bibbo, David Yang, Petr Jarolim, Mark W Feinberg, Alexander Lin, Marc P Bonaca, MARCELO DI CARLI
Journal: Circulation (2022)

Background and Aims: Intermittent claudication (IC) in patients with peripheral artery disease (PAD) is thought to be caused by reduced lower extremity macrovascular blood flow. However, the ankle-brachial index (ABI) (a macrovascular measure) does not correlate well with patient-reported outcome measures. We aimed to study microvascular and metabolic skeletal muscle responses to exercise in patients with IC using positron emission tomography (PET). Methods: We enrolled 19 patients with IC (ABI &amp;lt; 0.90 and imaging/angiographic evidence of PAD) and 12 healthy controls (HCs) (normal ABI). All subjects underwent rest perfusion imaging of the legs with 13 N-ammonia or 11 C-acetate PET followed by a graded treadmill test. Subjects exercised until limited by claudication or the end of the 20-minute protocol. Subjects then underwent immediately post-exercise PET imaging of the legs. Skeletal muscle blood flow (SMBF) was quantified in each leg at rest and immediately post-exercise. Skeletal muscle oxygen utilization (SMVO 2 ) normalized to SMBF was also quantified for patients who underwent imaging with 11 C-acetate. Peripheral artery questionnaire (PAQ) summary score was obtained for all subjects. Results: We found that SMBF was increased post-exercise in all subjects, and stress/rest SMBF was higher in the legs of subjects with PAD than in the legs of HCs ( Figure 1A ). We also found that stress SMVO 2 /SMBF was higher in legs of patients with PAD than in the legs of HCs ( Figure 1B ). There was a moderate, significant correlation between limb stress/rest SMBF and PAQ score ( Figure 1C ) and a strong, significant correlation between limb stress SMVO 2 /SMBF and PAQ score ( Figure 1D ). Conclusions: In conclusion, we found that SMBF increased in all subjects after treadmill exercise and paradoxically to the greatest degree in patients with IC. We also found that PET-derived markers of post-exercise microvascular perfusion and metabolism correlated with patient-reported outcomes.
Abstract 10432: Variables Associated With Mortality in Patients With ST Elevation Myocardial Infarction and Heart Failure at Admission. Registry ARGEN-IAM-ST
Authors: Cesar R Zoni, Heraldo D'Imperio, Gerardo Zapata, Adrian Charask, Stella M Macin, Yanina Castillo Costa, Juan Gagliardi, Eduardo R Perna
Journal: Circulation (2022)

Introduction: Hemodynamic complications associated with ST elevation myocardial infarction (STEMI) continue to be an unfavorable prognostic marker in patients (pts) who develop it. Objectives: Know the demographic, clinical, laboratory, electrocardiographic, and reperfusion variables associated with the change in mortality of STEMI patients with heart failure (HF) at admission. Material and Method: Data from the National Registry of STEMI of Argentina (ARGEN-IAM-ST) from 1/1/2016 to 9/30/2020 were analyzed. Pts with Killip and Kimball equal to or greater than 2 at admission were included. They were divided into alive vs dead according to this condition during hospitalization. Demographic, clinical, electrocardiographic, laboratory variables, and reperfusion characteristics at admission were compared. Univariate and multivariate analyzes were performed. Results: 708 pts were included. Mortality was 28.39% (N=201) (Figure 1). When comparing the alive vs dead groups, the mean age was 62.96 (SD±12.02) vs 66.70 (SD±12.05) years, p=0.0002; women 21.10% (N=107) vs 32.30% (N=65), p=0.002 respectively. The baseline characteristics are observed in Table 1. Reperfusion was performed in 88.56% of alive vs. 85.07% of dead [OR 0.74 (95%CI 0.46-1.18), p=0.2]. Successful reperfusion by primary percutaneous coronary intervention (PPCI) was more frequent in the alive, 96.59% vs 76.15% [OR 0.11 (95%CI 0.05-0.23), p&lt;0.001], table 2. In multivariate analysis, successful reperfusion with thrombolytics was associated with a decrease in mortality, OR 0.19 (95 %CI 0.04-0.81), p=0.025; as well as successful reperfusion with PPCI, OR 0.11 (95%CI 0.05-0.28), p&lt;0.001. The rest of the variables that modified survival are shown in Table 3. Conclusions: Patients with STEMI who are admitted with HF and die during hospitalization have different baseline characteristics than those who survive. Successful reperfusion therapy is associated with decreased mortality.
Abstract 10565: Personalized Virtual Heart Approach Representing Fatty Infiltration (inFAT) in Arrhythmogenic Right Ventricular (RV) Cardiomyopathy (ARVC) Predicts Ventricular Arrhythmia (VA) Reentrant Circuits and Ablation Targets: A Pilot Study
Authors: Yingnan Zhang, Adityo Prakosa, Eric Sung, Alessio Gasperetti, Richard Carrick, Cynthia James, Stefan Zimmerman, Crystal Tichnell, Brittney Murray, Hugh G Calkins, Harikrishna S Tandri, Natalia Trayanova
Journal: Circulation (2022)

Introduction: inFAT is a pathological hallmark in ARVC that is associated with pro-arrhythmic remodeling that contributes to the substrate for VA. Identification of the inFAT distribution on contrast-enhanced computed tomography (CE-CT), which is highly accessible and has reliable image quality, may be useful in pre-procedural planning for catheter ablation treatment of VA. Objective: We aimed to develop and validate a novel non-invasive CT-based computational approach for VA ablation targeting in ARVC. Methods: As a retrospective pilot study, we constructed 3D personalized computational models of ARVC patient hearts with implanted cardioverter defibrillators from CE-CT scans representing the patient-specific inFAT distribution in the RV (Fig A, B). Three patients were included. P1 and P2 had clinical VA and electrophysiological study with ablation. P3 did not present with clinical VA and did not have ablation. We evaluated the inducibility of each model via rapid pacing and compared the results to electroanatomic voltage maps (EAM). In-silico ablation was performed and compared to clinical ablation locations (Fig C). Results: For all 3 patients, heart model predictions corresponded well with clinical observations.In both P1 and P2, reentrant circuits’ locations matched clinical records (Fig C). Both reentrant circuits manifested at the border of inFAT and fat-myocardium admixture, where tissue heterogeneity was prominent. Regions of inFAT co-localized well with low-voltage areas on EAM. Predicted ablation sites successfully terminated VA and coincided with the clinical ablation locations. In P2, the predicted ablation yielded a much smaller lesion than clinical ablation. For P3, the model correctly predicted that VA could not be induced in the heart. Conclusions: Our novel ARVC CT-based computational approach accurately predicts VA ablation targets and could potentially become a highly accessible tool in assisting ARVC ablation.
Abstract 10308: Advanced Age Without Percutaneous Coronary Intervention is Associated With Adverse Outcomes in Patients Admitted With St-Segment Elevation Myocardial Infarction: Nationwide Inpatient Sample Analysis
Authors: Kahtan Fadah, Debabrata Mukherjee
Journal: Circulation (2022)

Introduction: Coronary artery disease (CAD) in older adults ≥80 years of age is very common and a major cause of morbidity and mortality. Invasive management such as percutaneous coronary intervention (PCI) is sometimes held based on the prediction of poor prognosis, functionality, or advanced comorbidity. Methods: Here, we examined the Nationwide Inpatient Sample (NIS) data for baseline characteristics and clinical outcomes in ST-segment elevation myocardial infarction (STEMI) for elderly patients with and without PCI. Results: Out of 416195 patients over the age ≥80 of years with primary diagnosis of STEMI, only 39220 (42.3%) underwent PCI. Half of those patients were female (50.7% versus 49.3 %, p&lt;0.001). Patients with baseline characteristics of congestive heart failure (CHF), and renal failure (RF), metastatic cancer disease were less likely to undergo PCI (44.1 % versus 34.2%, 32.7% versus 26.1%, 11.53% versus 9.12%, p&lt; 0.001) respectively. Inpatient hospital mortality for STEMI group without PCI intervention was twice as much compared to those who underwent PCI (45.4% versus 27.6%). Mean length of stay was slightly higher in STEMI patients without PCI (4.44 versus 4.38, p&lt;.0001), while total hospital charges were higher in the PCI group ($114830 ±98516 versus $86131 ±110993, p &lt;.0001). Moderate to severe disability was associated with less PCI intervention (35.5% versus 22.1%, p&lt; 0.001). Furthermore, based on All Patient Refined DRGs (APR-DRG) severity scale, patients with severe loss of function were less likely to be selected for PCI 32.4% versus25.6%, p&lt; 0.001) Conclusions: Advanced age was associated with poorer hospital outcomes in STEMI patients without PCI. Disability severity and APRDRG severity scale were associated with decision not to perform PCI. Older patients with baseline comorbidities of CHF, RF, and metastatic disease were also less likely to undergo PCI after STEMI.
Abstract 10065: Higher Cholesterol Absorption Marker at Baseline Predicts Less Cardiovascular Events in Elderly Patients With Hypercholesterolemia Treatment: Kyushu Elderly Ezetimibe Phytosterol (KEEP) Study
Authors: Yasuyoshi Ouchi, Jun Sasaki, Shinichi Oikawa, Kiyotaka Nakagawa, Masao Sato, Shinji Koba, Tetsunori SAIKAWA, Masanari Kuwabara, Hidenori Arai
Journal: Circulation (2022)

Introduction: Serum cholesterol levels depend on both cholesterol synthesis in the liver and absorption in the intestine. The higher absorption of cholesterol is reported to be related to a higher incidence of cardiovascular events (CVEs). Hypothesis: When treated with a cholesterol absorption inhibitor, higher cholesterol absorption marker could be associated with less CVEs. Methods: The participants in the Kyushu Elderly Ezetimibe Phytosterol (KEEP) study were the intension-to-treat (ITT) population of the EWTOPIA75 study which has proved the beneficial effect of ezetimibe on the prevention of CVEs in the elderly older than 75 years old (Ouchi Y, et al: Circulation 140:992-1003, 2019). A total of 1,131 participants were randomly assigned to a group receiving diet therapy only (diet group) and a group receiving ezetimibe (10 mg/day) in addition to diet therapy (ezetimibe group), and were followed up for 4 years. Blood sampling was performed at baseline and at 24 weeks of follow-up to measure serum lipids and related compounds including cholesterol absorption and synthesis markers. Serum N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) were also measured. The data of 1,061 participants (501 in the ezetimibe group and 560 in the diet group) were analyzed. Results: The mean age of participants analyzed was 80.5+/-4.8, and the female to male ratio was 3.2. The number of CVEs was 64. Both higher levels of campesterol (cholesterol absorption marker) and campesterol/lathosterol (cholesterol synthesis marker) ratio at baseline were significantly associated with lower risk of CVEs by ezetimibe (p=0.01 and p=0.04, respectively). No interaction of either lathosterol or campesterol with ezetimibe treatment on CVEs was found. NT-pro BNP was significantly associated with the risk of CVEs (p=0.004), but not hs-CRP. Conclusions: The KEEP Study has revealed that CVEs were significantly reduced in hypercholesterolemic participants with higher levels of campesterol, suggesting a rationale to treat patients with higher level of cholesterol absorption marker by ezetimibe which has been proved to be effective for the prevention of CVEs.
Abstract 10426: An Interesting Presentation of Angina Due to Left Posterolateral to Right Posterolateral Coronary Artery Fistula
Authors: Vivek Nadipalli, Ahmed Mahmood, Muhammad Uzair Lodhi, Bilal Hussain, Sohail Khan, christel cuevas, Thomas Alexander
Journal: Circulation (2022)

Background: Arterial-to-arterial fistula between right posterolateral and left posterolateral coronary arteries is rare and available literature on it is scarce. Case Presentation: A 60-year-old male with type 2 diabetes mellitus and dyslipidemia presented with shortness of breath and chest tightness. Given his symptoms and poor functional status, myocardial perfusion imaging with regadenoson was performed. The myocardial perfusion imaging study was abnormal with evidence of ischemia in the inferoseptal myocardium. The patient proceeded to the cardiac catheterization lab for selective right and left coronary angiography. Contrast injection revealed non-obstructive coronaries; however, an arterial-to-arterial fistula between the right posterolateral (RPL) branch and left posterolateral (LPL) branch was present (Figure 1A and 1B). Further characterization of the fistula showed the presence of left-to-right and right-to-left filling, indicating a LPL to RPL coronary artery fistula (CAF). The patient was managed conservatively with aspirin, statin, and anti-anginal therapy. Conclusion: There remains a need for diagnostic and therapeutic guidelines to address CAF. Conservative treatment is an option for small CAFs and serves as a potential alternative to catheter-based and surgical closure.